Scar Revision

Scar revision is a highly individualized procedure and you should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.

Scar revision can be performed on people of any age and is a good option for you if:

• You are bothered by a scar anywhere on your body
• You are physically healthy
• You have a positive outlook and realistic goals for your scar revision surgery
• You do not have active acne or other skin diseases in the area to be treated

Scars can be treated anywhere on the face and body.

Some people produce better scars than others.

A 'good' scar fades significantly after appearing and blends in with the surrounding skin tone. A 'poor' scar, such as a keloid or hypertrophic scar, will stay visible and cause skin irritation for a number of months after formation. When these 'poor' scars fade they tend to whiten, flatten but, remain visible.

Good scars have the following characteristics:

• Often caused by having the right genes. Some people simply scar better than others. Darker skin is more prone to make the worst scars, so too Celtic skin and those with red hair at the opposite extreme are also often poor scar makers
• The scar is in the right direction in the lines of skin tension. Experienced trained surgeons will choose to position scars properly as for instance transversely across the abdomen rather than vertically downwards.
• Located in naturally optimal areas, such as by avoiding the centre of the chest or tip of the shoulder
• Scars may be hidden discretely below areas such as the breast, behind the ear, in the groin or in the armpit (axilla).
• Influenced early by proper surgical care. Surgeons can influence the result by meticulous technique and using dissolving sutures or glue and removing other stitches early enough to avoid stitch marks.

Your scar revision surgery will be performed by one of our trained plastic surgeons and scar specialists. We are proud to have scar specialists trained in the military who are experts in soft, tissue reconstructive surgery and experts in the scarring process.

There is very little preparation prior to scar revision surgery, however, at your consultation with your surgeon you may be asked to do the following in advance of your treatment:

• Take certain medications or adjust your current medications
• Stop smoking well in advance of surgery
• Avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding

Scar revision surgery can last anywhere between 20 minutes to 1 hour and is performed as a day-case treatment under local anaesthetic.

We are passionate about scar treatment and scar management and offer all types of Scar Revision treatment at the Cadogan Clinic.

These range from the surgical to the non-surgical (e.g. ICON Laser, IPL, Dermal Fillers, Enerjet etc.).

It is vital that you speak to one of our specialists to develop the right programme for you.

Scar revision surgery is most commonly performed to improve the cosmetic appearance of a scar, however, it is also frequently performed for functional reasons as well.

This is most commonly the case in the instance of 'contracture'. This occurs when the formation of a scar interferes with the movement of the underlying muscles and joints, such as when a shortening or tightening of the skin causes a corresponding tightening impact on the underlying muscles. Contractures may interfere with a range of motion and other aspects of joint functioning, as well as deform the shape of the scarred body part or affect key muscle groups, such as the muscles in the face responsible for controlling facial expressions.

The final results of your scar revision surgery will be long-lasting, however, it may take several months for your final results to become apparent and in some cases, it may take a year for the new scar to fully heal and fade.

Scar Revision takes place under local anaesthetic. You should not feel any pain during the procedure, and pain should be minimal during the healing process.

You may have a little swelling or bruising after treatment, as well as minor skin colour changes. These may last for 1 to 2 weeks after your surgery.

It is not uncommon to experience altered sensation following your treatment. This may either manifest in increased sensitivity (apart from the early discomfort of surgery), or the reduction in feeling around the treated area. These changes in sensation usually last for a month or so following surgery.
 

There is very little downtime after scar revision surgery. Most patients will be able to return to work the same day or the following day. Your surgeon will give you clear instructions at your consultation.

We strongly recommend that you do not sit out in strong sunlight for the first 2 weeks after surgery.

Once fully recovered and the scars are matured you may expose areas on the body or face that have been treated as per normal.

Scar quality is extremely important to us and to our patients. To mitigate the risk or impact of scars, we take a proactive scar management approach to all surgical activity done on-site.

All patients undergoing surgical procedures with us are eligible for this treatment, but this will be of particular interest to patients who could potentially have larger scars in areas of the body where they could be an issue. In particular, after breast surgery, abdominal reduction and facelifts.

Our care programme includes:

• Bespoke, tailored advice from our post-operative wound care nursing team
• 24-hr access to our on-call nursing team to answer any questions
• Access to core follow up treatments

Some patients may be advised to undergo:

• PRP: healing factors (platelet-rich plasma) are taken from your own blood and injected under the scar to promote healing and tissue rejuvenation.
• Micro-needling or 'collagen induction therapy'. This involves using fine needles to create hundreds of tiny, invisible puncture wounds in the top layer of skin. These micro-injuries are virtually painless and stimulate the body's natural wound healing processes resulting in increased collagen and elastin production, tissue regeneration and skin repair
• Steroid Injections: A highly effective treatment for lowering and taking inflammation out of established active scars and for those at risk of developing keloids.
• Irradiation for keloids: a treatment via superficial radiotherapy to prevent keloids from forming post-surgery. In the case of existing keloids, they can be excised and the new wound treated with irradiation to prevent a new one from forming.
• Repair cream (Ticalfate, Cicaplast): a useful adjunct, but given for patient comfort rather than efficacy.

Whilst we cannot guarantee a perfect scar, we can guarantee that our scar management programme will give your body the very best chance to heal and recover properly.

The most important aspect of long-term aftercare is protecting the affected area from the sun because the surgical scar will take about a year to mature and is only about 80% as strong as undamaged skin. Sunlight can cause burns, permanent redness, loss of pigment in the skin, and breakdown of the collagen that maintains the skin's elasticity.

Aftercare following the use of skin grafts or flaps is slightly more rigid. You will be scheduled to return to the Clinic at regular intervals so that your graft sites can be monitored. If artificial skin has been used you must keep the site(s) completely dry until advised otherwise – this may require specific restrictions around bathing or showering as well as clothing choice, i.e. wearing loose comfortable clothing can help reduce the disturbance to the treated area.

Massaging the treated areas after surgery when comfortable enough to do so (usually 2 weeks following surgery) is a very important part of the healing process and helps to soften your skin, adjacent tissue, and helps accelerate healing - you will be given exact instructions about aftercare and which movements when massaging would be best.

Skilled surgeons can influence the quality of the scar by choosing the optimum position and orientation of the scar during surgery.

For instance, a vertical scar in front of the ear will be a good scar, while a transverse scar across the cheek will be a poor scar. Our surgeons aim to keep the scar as short as possible and to repair the wound with appropriate stitches. Any conventional stitch through the skin will need to be removed early to avoid stitch marks. In many areas of the body, the surgeon will choose to use dissolving suture materials under the skin, thus avoiding stitch marks altogether.

Any signs of slow healing or infection are treated promptly by our expert team. Prolonged redness or raised keloid scars are treated early, as well as patients with olive or darker skin may develop extra pigmentation around the scar, called post-inflammatory inflammation (PID).

At the Cadogan Clinic, we are passionate about scar management. This is because, with due care and consideration, a far superior outcome can be achieved on a patient by patient basis if the right process is adopted from the outset of treatment and the right treatments applied.

We have the skills in-house to dramatically improve patient outcomes, and we are passionate about delivering them to the widest possible audience via our programme.

Obstetricians are clever at creating high-quality Caesarian Section scars, but cannot avoid all potential problems. They try to place the scar transversely low on the abdominal wall below the bikini line.

However, the low scar through pubic hair is also wherein a small proportion of patients risk keloid scars. We now have a genetic test to assess this risk before surgery and can treat the scar itself with Cadogan Scar Management.

The bigger problem is swelling above the scar which bulges through tight clothing. The cause is the tethering of the healing scar to deeper structures as it heals and is difficult for the obstetrician to avoid. It is a problem for even the skinniest patient but becomes more significant for plumper patients. We can surgically revise these scars very effectively at the Cadogan Clinic removing the bulge (Cadogan Caesarian Section scar revision), either under local or general anaesthesia as a day case.

Patients with stretched loose skin and more subcutaneous fat will often benefit from a mini-abdominoplasty, which includes the removal of surplus skin and liposuction of the lower abdominal wall.

Patients, who have Caesarian sections performed in a hurry, often undergo the  Classical Caesarian Section with a vertical midline abdominal scar. The scar is not only difficult to hide but also of lesser quality. Cadogan Scar management becomes a more likely option.

Patients who have multiple caesarian sections sometimes end up with multiple scars. We can revise these to replace them with a single good quality scar.